Core Curriculum in Nephrology
Installments of the Core Curriculum in Nephrology provide trainees in nephrology with a strong knowledge base in core topics in the specialty by providing an overview of the topic and citing key references, including the foundational literature that led to current clinical approaches.
- Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research. The kidney has several critical functions; GFR is used as an overall assessment of these kidney functions. GFR is used to diagnose, stage, and manage chronic kidney disease (CKD); ascertain the prognosis for chronic kidney disease–related events and mortality; and determine drug dosages. GFR is the rate at which the glomerulus filters plasma to produce an ultrafiltrate and can be assessed from clearance or serum levels of filtration markers.
- Medications are an important part of the management of patients with kidney disease. When used appropriately, pharmacotherapy can slow disease progression and reduce morbidity and mortality. Unfortunately, reduced kidney function can significantly alter the pharmacokinetics and pharmacodynamics of many medications, putting patients at risk for drug toxicity if modifications to therapy are not appropriately managed. Adding complexity to the appropriateness of medication and dosage selection is the difficulty in estimating kidney function and the discordance between the Cockcroft-Gault–derived dosing cut points in most medication package inserts and the estimations of glomerular filtration rate by newer and generally more accurate guideline-recommended equations.